title: Prevalence of and factors associated with subclinical posttraumatic stress symptoms and PTSD in urban and rural areas of Montana: a cross-sectional study.
abstract: OBJECTIVE
  Posttraumatic stress disorder (PTSD) is an important clinical problem, but little is known about PTSD in rural, nonclinical populations. To better understand PTSD in rural areas, we examined the prevalence and risk and protective factors in urban, rural, and highly rural communities in Montana for both subclinical posttraumatic stress symptoms (PTSS) and PTSD.
  
  
  METHODS
  We compared the prevalence of PTSS and PTSD in urban, rural, and highly rural communities in bivariate and multivariable regression analyses using self-reported cross-sectional survey data from the Montana Health Matters study (N = 3,512), a state-representative household-based survey done in 2010-2011. We also explore potential risk and protective factors for PTSS and PTSD and whether risk and protective factors for each differ by rurality.
  
  
  RESULTS
  There were no differences in the level of PTSS by rurality in bivariate or multivariate models, and the bivariate relationship between rurality and PTSD became nonsignificant in a multivariate model. Only locus of control was predictive for PTSS; however, gender, age, marital status, income, employment status, community fit, locus of control, and religiosity were associated with PTSD. Some risk and protective factors operate differently by rurality.
  
  
  CONCLUSIONS
  Although our findings are subject to weaknesses common to cross-sectional data and are based on questionnaire reports, it appears that there are different risk and protective factors for PTSS and PTSD, suggesting that PTSD may be qualitatively different from PTSS. Furthermore, differences in risk and protective factors across urban and rural communities suggest more attention is needed to understand PTSD in rural communities.
authors.affiliation: Department of Sociology, Brigham Young University, Provo, Utah.
authors.forename: Lance D
authors.initials: LD
authors.lastname: Erickson
authors.forename: Dawson W
authors.initials: DW
authors.lastname: Hedges
authors.forename: Vaughn R A
authors.initials: VR
authors.lastname: Call
authors.forename: Byron
authors.initials: B
authors.lastname: Bair
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009009:Montana / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014505:Urban Population
keywords: mental health; posttraumatic stress; risk/protective factors; social determinants of health; veterans